How to Know If You Have PCOS

You might have PCOS (polycystic ovary syndrome) if you experience symptoms like irregular periods, hair loss, acne breakouts, and unusual hair growth on the face or body. These symptoms may begin around the time of your first menstrual period or years later. Many common symptoms of PCOS also occur in other conditions, however, so it’s important to get a diagnosis from a healthcare provider.

PCOS is characterized by an overproduction of male hormones and cysts in the ovaries. PCOS can interfere with your reproductive and metabolic health and cause numerous symptoms. It is a leading cause of infertility.

This article will explore some of the common symptoms of PCOS and how the condition is diagnosed.

Cysts

People with PCOS may have small, painless, fluid-filled sacs on the ovaries. These are called “cysts,” though they are actually follicles, or underdeveloped sacs that contain immature eggs. In people with PCOS, the follicles don’t release eggs as they are supposed to. The ovaries may also become enlarged.

Not everyone with PCOS has cysts. If you do have them, you may not know it until your healthcare provider finds them during an imaging test.

Irregular Periods

People with PCOS don’t ovulate regularly. This interferes with the development and shedding of the uterine lining. Instead of shedding during a regular menstrual period, the lining thickens and sheds irregularly. This can cause heavy or prolonged bleeding that happens unpredictably and/or infrequently.

Abnormal Hair Growth (Hirsutism)

The high androgen levels of PCOS lead many people to develop coarse, dark hairs on the face and on body parts where men typically have body hair and women just have vellus hair (“peach fuzz”). This condition is called hirsutism.

While hirsutism is a sign of possible PCOS, it may also be due to several other conditions, such as:

• Adrenal tumor or cancer
• Congenital adrenal hyperplasia, an adrenal gland disorder
• Cushing’s syndrome, an endocrine disorder
• Hyperthecosis, or a series of changes affecting ovarian cells that leads to greater production of androgens
• Ovarian tumor or cancer
• Thyroid disease

Not everyone with PCOS has hirsutism. But between 70% and 80% of women with hirsutism have PCOS.

Infertility

PCOS is one of the most common causes of infertility in women. This may be the hardest part of the disease for women who want to have a baby, now or in the future. Because PCOS can interfere with ovulation, it can cause difficulties getting pregnant.

Talk to your healthcare provider if you’ve been skipping periods or have them irregularly. Just keep in mind that other things can also interfere with conception, including:

• Age-related infertility
• Endometriosis
• Low body weight
• Obesity
• Premature menopause
• Premature ovarian insufficiency
• Structural problems in the reproductive organs
• Thyroid disease

Weight Gain

People with PCOS often have insulin resistance. This can lead to weight gain, especially around the belly. It can also make it harder to lose weight.

One of insulin’s jobs is promoting fat storage. But some people with PCOS gain weight even when they eat a healthy diet, avoid binges, and get regular exercise.

If you have insulin resistance, you may also feel excessively thirsty or have frequent urination.

Fatigue

Fatigue is a possible symptom of PCOS, but it’s also a symptom of many other illnesses and lifestyle factors. This reality makes it nearly impossible to diagnose any condition based on fatigue alone. It has to be looked at in the context of your life and any other symptoms you may be experiencing.

Lifestyle factors that can cause fatigue include:

• Inadequate sleep
• Long work hours
• Medication side effects
• Nutritional deficiency
• Stress
  

Chronic conditions involving extreme fatigue that can have a severe impact on your life and ability to function include:

• Anemia
• Autoimmune diseases
• Cancer
• Chronic infection
• Depression
• Diabetes
• Fibromyalgia
• Heart disease
• Myalgic encephalomyelitis (chronic fatigue syndrome)
• Sleep disorders, such as sleep apnea and insomnia
• Thyroid disease

To help you and your healthcare provider figure out what’s causing fatigue, look for possible triggers. Do you get tired after eating certain foods? After a stressful event? After a small amount of exertion?

Try to describe the specifics of your fatigue. Is it a “kind of tired all the time but functioning” fatigue or does it keep you in bed for days at a time? Does it come and go? Is it accompanied by pain or depression symptoms? Every piece of information ought to help your provider fit the puzzle together.

Mood Swings

You probably already know that female hormones can cause mood swings, especially at certain times during the menstrual cycle. It may be hard to tell them apart from PCOS mood swings. However, PCOS often disrupts your cycle by preventing ovulation, so if you’re missing periods and having mood swings, PCOS is a possibility.

It’s theorized that mood swings are associated with PCOS because of abnormal brain chemistry and the potential disruption of the brain-gut connection. This refers to the chemical and physical links between the brain and the gastrointestinal tract. Beyond mood swings, some studies show that PCOS may possibly be associated with an increased risk of diagnosis of depression, anxiety, bipolar disorder, and obsessive-compulsive disorder. It is also linked to worse symptoms of depression, anxiety, OCD, and somatization (when emotional distress shows up in the form of physical symptoms).

Acne

Testosterone—the primary male hormone—is a cause of acne, so the high levels associated with PCOS can lead to breakouts. Not all adult acne is due to PCOS, though. Common causes include:

• Family history
• Hormonal fluctuations (linked to periods, pregnancy, menopause)
• Medication side effects
• Reactions to skincare products
• Stress

Migraines

Little research has been done involving migraines and PCOS. But a 2019 study appeared to suggest the link. It found that migraines are “highly associated” with PCOS.

Many people without PCOS have migraines, though. Migraines could be an indicator of PCOS if you:

• Never had them until you started having other symptoms suggestive of PCOS
• Have had them before but have noticed a change in frequency and potential triggers
• Tend to have migraines at certain points in your menstrual cycle
• Have them when other potential PCOS symptoms are especially bad

Hair Loss

Hair loss in PCOS is sometimes called female androgenic alopecia (FAGA) or female pattern hair loss. It happens because of the androgens (male hormones) associated with PCOS. Similar to male pattern baldness, FAGA causes thinning hair on top of the head and along the hairline. It doesn’t result in baldness, as it does in men, because the follicle doesn’t die. This means the hair may grow in again. Multiple conditions other than PCOS can cause FAGA, including:

• Menopause
• Hyperprolactinemia, a condition known for excess prolactin, the hormone that produces milk in a woman’s breasts
• Adrenal hyperplasia, an adrenal gland disorder
• Ovarian and adrenal tumors (rarely)

Several other conditions can cause general thinning of the hair all over rather than in the distinctive pattern of FAGA. They include:

• Anemia
• Autoimmune disease
  
• Thyroid disease
• Syphilis

Some medications may cause non-patterned hair thinning as well. Ask your healthcare provider if your medication is on the list.

Sweet Cravings

Craving sweets all the time is a common symptom of PCOS, likely due to insulin resistance. Women with PCOS tend to have high levels of insulin in their blood. All that insulin can interfere with the function of other appetite-regulating hormones, leading to increased hunger. Eating sugar and refined carbs, in particular, can lead to sugar-rush-and-crash cycles that trigger even more cravings.

PCOS cravings can lead to unhealthy behaviors. For example, people with PCOS are especially prone to binge-eating. If you’re obese, you’re more likely to have a lot of food cravings, which makes weight loss harder.

To gauge whether your cravings could be insulin-related, watch for symptoms of low blood sugar. They can surface a few hours after a binge, when high insulin levels can cause blood sugar levels to plummet. Symptoms include:

• Anger brought on by being hungry
• Dizziness
• Headaches
• Irritability

Darkening of the Skin

People with PCOS can develop dark patches of skin called acanthosis nigricans. These dark patches often appear around the neck or in the underarm area, though they can appear anywhere on the body. They can be brown, purple, or black and may have a velvety appearance.

Acanthosis nigricans are a symptom of insulin resistance, so the first step in treating them is to treat your insulin resistance. The discoloration will often fade as you lose weight and adopt a healthy diet.

Can Polycystic Ovaries Make You Feel Sick?

People with PCOS don’t usually feel sick, though fatigue is a common symptom. Because fatigue can be caused by common issues like trouble sleeping or stress, it can be easily dismissed. This is one reason why PCOS often goes undiagnosed for long periods of time.

How Healthcare Providers Diagnose PCOS

If you suspect that you may have PCOS, pay attention to your symptoms and their triggers. Most importantly, see your healthcare provider. Because the symptoms listed here can be traced to other conditions, it can take a while for your healthcare provider to be certain of your diagnosis. You might need the following tests to confirm it:

• A pelvic examination
• Blood tests
• Ultrasound or other imaging tests

The diagnostic criteria for PCOS includes:

• Polycystic ovaries (12 or more small follicles in each ovary)
• Hyperandrogenism (elevated testosterone, or DHEA)
• Ovulatory dysfunction (less frequent or absent periods)

If you are diagnosed with PCOS, it may help to know that numerous treatment options can help you manage the symptoms. For example, even a 5% weight loss can relieve many PCOS symptoms—and make living with the condition more bearable, day to day.

Additional Tests After PCOS Diagnosis

After you’ve been diagnosed with PCOS, your healthcare provider may want to screen you for complications and conditions that can occur alongside polycystic ovary syndrome. Some additional tests you may need include:

• Glucose tolerance test (every two to five years)
• Lipid blood tests to check your cholesterol and triglycerides (every two years)
• Ongoing blood pressure monitoring
  

Because complications like diabetes can occur at any time, it is important that you get these screenings regularly as directed by your healthcare provider.

Summary

Polycystic ovary syndrome can disrupt your menstrual cycle and interfere with your fertility. Since PCOS can also put you at higher risk for type 2 diabetes, you’ll want to stay alert to PCOS warning signs like irregular periods, unusual hair growth, weight gain, acne, hair loss, and darkening of the skin.

Many of these symptoms overlap with other conditions, but if your periods are irregular and you have two or more of these symptoms, it’s wise to make an appointment with your healthcare provider to be checked for PCOS.